Emergency medical technician
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An emergency medical technician ('EMT') is an emergency responder trained to provide emergency medical services (EMS) to the critically ill and injured.
Once thought of as an "ambulance driver or attendant," the modern EMT performs many more duties than in the past, and responds to many types of emergency calls, including medical emergencies, hazardous materials exposure, childbirth, child abuse, fires, injuries, trauma and psychiatric crises.
EMTs are trained in basic medical knowledge and skills. Patient treatment guidelines are described in protocols following both national guidelines and local medical policies. The goal of EMT intervention is to rapidly evaluate a patient's condition and to maintain a patient's airway, breathing and circulation by CPR and defibrillation. Also, to control external bleeding, prevent shock, and prevent further injury or disability by immobilizing potential spinal or other bone fractures, while expediting the safe and timely transport of the patient to an hospital emergency department for definitive medical care.
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Certification
In the United States, EMTs are certified according to their level of training. Individual states set their own standards of certification (or licensure, in some cases). All EMT training must meet the minimum requirements as set forth in the U.S. Department of Transportation's standards for the EMT-B (Emergency Medical Technician - Basic) curriculum.
The National Registry of Emergency Medical Technicians (http://www.nremt.org/about/nremt_history.asp), a voluntary standards and testing body, recognizes three levels of EMT: EMT-B (Basic), EMT-I (Intermediate) and EMT-P (Paramedic). Some states such as California use an EMT-I or "EMT-One" Roman numeral designation which is equivalent to the National EMT-Basic; this should not be confused with the EMT-Intermediate (hereafter EMT-I). New York State (and several others) have an EMT-CC (Critical Care) certification, however this is not a national standard. An ambulance with only EMT-Bs is considered a BLS or Basic Life Support unit whereas an ambulance with EMT-Ps is dubbed an ALS or Advanced Life Support unit.
EMT-B skills include CPR, first aid, airway management, oxygen administration, spinal immobilization, bleeding control and traction splinting. EMT-I skills add IV therapy, endotracheal intubation and initial cardiac drug therapy. Both EMT-I (Intermediate) and EMT-P require something similar to a residency to attain; an EMT-B is the highest level of training one can receive without actively functioning as an EMT and being sponsored by one's EMS (Emergency Medical System/Service) organization or a hospital.
Medical Direction
Regardless of their level of training, an EMT's actions in the field are governed by state Regulations, local regulations, and by the policies of their EMS organization. The development of these rules is guided by a physician, often with the advice of a medical advisory committee. A physician acting in direct supervision of an EMT program is referred to as a Medical Director and the supervision provided is referred to as Medical Direction.
In California, for example, each county Emergency Medical Service Authority (EMSA) issues a list of standard operating procedures, under the supervision of the statewide EMSA. These procedures often vary from county to county based on local needs, levels of training and clinical experiences. In other areas a list of permitted actions ("Acts Allowed" list) is issued by a state or local authority.
Some EMTs may be authorized to perform advanced medical skills such as the use of intravenous fluids ( IVs). Some skills may be performed "by protocol" given that certain conditions exist, or "off-line medical direction." Other skills require the prior approval of a physician by radio or telephone, or "on-line medical direction." Some areas maintain an "Austere Care Protocol" which modifies the level of care provided during communications failures or disasters.
Paramedics (EMT-Ps) receive more advanced education and training, including instruction on pharmacology and the administration of lifesaving drugs; the technique of inserting a breathing tube into a person's lungs as in intubation; and even surgical techniques such as sticking a hollow needle directly into the trachea (needle cricothyrotomy) or the chest when necessary to save a life.
For example, if air in the chest (outside of the lungs) tension pneumothorax is preventing the lungs from expanding, the chest must be decompressed to allow the lungs to expand normally and allow inspired air to reach the alveoli so that oxygen can enter the bloodstream.
The use of these invasive skills is governed by complex protocols intended to maximize the life-saving value of bringing these skills to the patient in the field while minimizing the risk of errors or additional injury to patients.
Employment of EMTs
EMTs may be employed by a commercial, hospital or municipal EMS (Emergency Medical Service) agency or fire department. Some EMTs may be employed by commercial ambulance services (usually) providing non-emergency patient transportation, or providing emergency medical services to "9-1-1" emergency calls under contract with municipalities or county goverments. Some EMTs may work in clinical settings, such as a hospital's emergency department, while others may be employed in an industrial setting, or for 'home health care' providers.
EMTs may be employed by private ambulance services, which usually provide non-emergency transportation of in-hospital patients. Many ambulance services provide transport for patients not experiencing an emergency, but nonetheless requiring medically supervised transportation. Such patients may include those being transferred between hospitals, bedridden patients being discharged to nursing homes or patients who are to undergo specialized treatment, therapy or diagnostic procedures.
Many firefighters and some police officers (particularly in the Highway Patrol) are now also cross-trained as EMTs. Some large companies, especially industrial facilities, even maintain their own in-house EMTs as part of the plant's firefighting or security guard force.
EMTs may also serve as an unpaid volunteer for a volunteer ambulance service, volunteer rescue squad or volunteer fire department, especially in rural areas. Rural communities often find it difficult to finance emergency medical services, and recruiting, training and retaining volunteer EMTs is a continuing challenge.
In response to nursing shortages, EMTs are being increasingly used in the emergency rooms and Intensive Care Units of hospitals.
Currently, in the United States of America, the busiest EMS service per ambulance is New Orleans' Health Department EMS, which responds to approximately 4,000 "911" calls per month, utilizing six ambulances for the entire city of about 500,000 people.
EMTs and paramedics of the New York City Fire Department's Emergency Medical Service Command, along with hospital employed EMTs and paramedics under its jurisdiction, responds to over 3,000 requests for 911 assistance daily; over 1.3 million calls annually (2003).